Pulmonary Edema

PULMONARY EDEMA
Fluid accumulation in lungs, causing impaired gaseous exchange leading to respiratory difficulty/ failure.

TYPES:
Cardiogenic
Non-cardiogenic

CLINICAL FEATURES:
Dyspnea
Cough
Pink frothy sputum
Restlessness
Excessive sweating

In chronic cases, there maybe:

Nocturia
Pedal edema
Orthopnea
Paroxysmal nocturnal dyspnea

MANAGEMENT OF ACUTE PULMONARY EDEMA

Diagnosis:

Clinical Signs:
Decreased peripheral perfusion
Pulmonary congestion
Use of accessory respiratory muscles
Wheezing, specially in basal zones
Pink frothy sputum

Radiographic Signs: on CXR:
Cardiomegaly
Vascular engorgement (interstitial and perihilar)
Kerley B lines
Pleural effusion (varies with severity)


Treatment:
Start on clinical judgement only, no time to waste.

Position: Nurse the patient in a propped up position, so the secretions don’t pool in the bases of lungs.
Relieving the dyspnea: Administer oxygen, so arterial pO2 comes up to 60%.
Administer IV furosemide (loop diuretic), which actys as a venodilator before its diuretic action comes into play, thus immediately relieves edema. Nitroglycerin potentiates the effects of loop diuretic, so it is usually also given. Mechanical ventilation is indicated if hypercapnea coexists.
Relieving the pain: Provide analgesia(morphine sulfate) if patient experiences any pain, as pain may exacerbate the dyspneic symptoms.
Supportive: Inotropic agents are indicated if patient is in cardiac block or shock, eg. dobutamine or PDE inhibitors.
Recombinant BNP: Nesiritide, indirectly increases cardiac output. It also produces diuresis and natriuresis, in conjunction with furosemide.
Acute hemodialysis and ultrafiltration: consider in patient with significantly renal dysfunction and diuretic resistance.
Heart catheterization
Correction of precipitating factors: HTN, MI, ischemia, acute valvular regurgitation, arrhythmias or volume overload should be corrected for.